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Have paroxysmal atrial fibrillation. What are the indications to try cryoablation? Taking Metoprolol

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I have paroxysmal atrial fibrillation and want to know what the indications would be to try Cryoablation? I am on Metoprolol 50 mg per day + 81mg ASA and i am still ging into A-Fib about once every year or so. That last time I was Cardioconverted (50J). I am not on any blood thinners at this time.

55 Male BMI 29
Fitness level: excellent
Posted Wed, 23 May 2012 in Hypertension and Heart Disease
Answered by Dr. Ravindra L Kulkarni 2 hours later

As per history by you, you are presently on treatment with beta blockers and aspirin for paroxysmal atrial fibrillation.

It is good that you never required anticoagulation that is blood thinners. And also frequency of once a year is very low.

Plan for this situation should include

1 Continue present medication

2 As you would like to know about cryo-ablation, you need to consult cardiologist and undergo electrophysiological (EP) studies. It is a day care procedure and helps us to find disturbances in conduction system of heart [which controls heart rate and rhythm].

3 If study reveals abnormal conduction pathway then generally we consider for cryo-ablation. So that it will prevent episodes of atrial fibrillation.

4 But as the frequency of episodes is low decision to undergo EP study will be based on cardiologist clinical examination and review of ECG reports. Sometimes ECG report also gives us idea about abnormal pathway in conduction system.

5 If EP study report comes normal then you need not worry about cryo-ablation and you can be safely managed on present medicines.

Hope this information will be useful.
Please feel free to ask any further query if you have.
Wish you a good health.
Above answer was peer-reviewed by
Follow-up: Have paroxysmal atrial fibrillation. What are the indications to try cryoablation? Taking Metoprolol 16 hours later
Thank you for your answer.

What is the criteria for anti-coagulation therapy?
Do you prescribe Pradaxa? XXXXXXX drug?
I am a cyclist and when my heart rate begins to drop, I get the following rhythm. bbbb----------bbbb---------bbbb------bbbbb Could this be a vagal response?

Thank you very much !!!
Answered by Dr. Ravindra L Kulkarni 12 minutes later
Thanks for writing back.
The following criteria are used to decide the need for anti-coagulation in patients with atrial fibrillation:
•     Frequent episodes of atrial fibrillation ,
•     Episodes of syncopal attacks
•     Episodes of TIA ( transient ischemic attacks) or stroke like condition where blood supply to brain is compromised
•     When size of left atrium is more than 50 mm on echo-cardiography
On this platform, I am not in a position to prescribe a drug. Pradaxa is a newer anti coagulant drug, which is to be started only after cardiologist examination and its need is established based on some of the conditions mentioned above .
The side effects like bleeding can be minimized especially when these drugs are prescribed in right dose and we monitor its action by testing PT-INR test every month. We need to maintain INR in the range of 2-3 to avoid complications.
About the rhythm, the drop in rate can be a vagal response. But in most of the athletes, the heart rate is also on lower side of normal range. It is a good XXXXXXX of an athletes’ heart health.
In your case, we can comment better if you can forward an old ECG report as scan copy if it is available. You can use the ‘Upload your reports’ section on the right.
But as frequency of episodes is very low and your heart rate is controlled, don't get panic about need of anticoagulant drugs . Let your cardiologist decide if you need them.
Hope this helps. I will be available for follow ups.
Above answer was peer-reviewed by
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